Failures in aged care must result in change

The following opinion piece appeared in the Herald Sun on Monday 10 August 2020

Like many in the community, COTA (Council on the Ageing) joins families and friends in the mourning the people we have lost in Victorian nursing homes during the pandemic – and we know this death toll will continue to rise.

It is a struggle to find the language to describe what has been happening in some Victorian nursing homes. Terms like ”system failure” or “significant outbreak” seem far too bland.

They don’t communicate the true horror of scores of people dying because those who should have been responsible for protecting them didn’t follow the social distancing and isolation rules in the community, or because some nursing homes were underprepared, were caught flat-footed, or hadn’t taken the risk seriously enough to practice prevention and rapid response to a case of COVID-19. I may be accused of exaggeration and prejudging the situation — but it is sadly close to the truth.

It’s true that aged care wouldn’t have a COVID-19 problem if transmission of the virus hadn’t exploded in the community and that’s not aged care’s fault. The cost of the second wave is horrendous for all. And it’s impossible to 100 per cent prevent COVID-19 from entering a nursing home because staff with no symptoms may work one or two shifts before having symptoms and getting tested.

But how a provider responds when a case is identified and what they do to immediately mitigate the risk is critical. Many providers have responded really well and prevented greater disasters, which is what we expect.  But we have had too many disasters that were avoidable because of the failings of a minority.

Based on evidence, the Aged Care Quality and Safety Commission has felt it necessary to write again to all providers about their standards obligations as regards infection control. And a dozen homes so far have had to be handed formal “Notices to Agree” to strict commission requirements.

Australians are rightly outraged at the failures in our aged-care system that have resulted in the illness and death of so many vulnerable older Australians.

Should we be surprised? We know there is huge variability of quality in aged care, and in management and governance. We still have a system based on institutionalising large numbers of very vulnerable, frail, health-compromised older people in settings that are inevitably high risk.

When the aged-care sector was congratulating itself on minimal infections and deaths during the first phase of COVID-19 (apart from at Newmarch House), I expressed my reservations. I thought this “success” was due to the community containing the virus by adhering to the lockdown, so there was almost no community transmission.

I said the jury was out on how well the aged-care sector would do if that changed. I am really disappointed that I was right.

However, while certain aged-care providers will doubtlessly be found guilty of terrible failures, the system that allowed them to let older Australians die due to neglect of standards must also be addressed.

For a growing number of people, the Royal Commission into Aged Care Quality and Safety has come too late.

Even more frustrating has been witnessing the same political process that built this system repeating its failings. It is disturbing how much finger-pointing and blame-shifting is going on while we are still in the middle of this crisis.
Many statements, some clearly wrong, about who or what is to blame seem to be motivated by agendas other than care and respect for the older Australians who have just died and are still dying, and those trying to stop that from occurring.

Old agendas people have run for years, well before COVID-19, are being trotted out as “silver bullets” when they are not. My appeal is for this point scoring to stop so we can focus fully on what needs to be done right now.

The disaster in our nursing homes is well and truly known. We don’t yet know the full situation in home care.

As of 6 August, 60 people receiving home care packages are known to have contracted COVID-19. Seven have died. There are about one million people receiving home care and support services n Australia.

There are risks for them from COVID-19 itself, because they and their carers live in the community. But clients are also at risk if their care is withdrawn because a provider is under pressure, or it’s not delivered appropriately, or at all, because of the lockdown measures impacting on availability of staff and services. All of that is happening now.

Lack of data on home care and support services makes the scale of these issues harder to monitor than in residential care and that’s a concern.

The many thousands of aged-care staff — including cleaners and cooks and more — plus carers, health workers, administrators and public servants who have so far saved so many lives during this pandemic deserve our praise. As do all people who assiduously follow the rules provided by the medical experts.

From the aged-care teams to the individuals maintaining social distancing or wearing masks and other PPE, it is heartening to see Australians going above and beyond to keep each other safe at this time.  Let us sincerely hope the immediate lessons of this second wave are taken on board so the same thing doesn’t happen in other states.

We also need to learn long-term lessons, so aged care gets better for all current and future older Australians. Our aged care system has been living in the past for too long. It now needs to radically and fundamentally change.